EP2658477A2 - Appareil et procédé de renfoncement continu de lobe latéral - Google Patents

Appareil et procédé de renfoncement continu de lobe latéral

Info

Publication number
EP2658477A2
EP2658477A2 EP11852778.7A EP11852778A EP2658477A2 EP 2658477 A2 EP2658477 A2 EP 2658477A2 EP 11852778 A EP11852778 A EP 11852778A EP 2658477 A2 EP2658477 A2 EP 2658477A2
Authority
EP
European Patent Office
Prior art keywords
anchor
needle
delivery device
prostate
distal
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP11852778.7A
Other languages
German (de)
English (en)
Other versions
EP2658477A4 (fr
Inventor
Matthew Mclean
Floria Cheng
Theodore C. Lamson
Joseph Catanese, Iii
Ling-Kang Tong
Michael Gearhart
Kevin Mcdermott
Ben Thompson
Earl A. Ii Bright
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Neotract Inc
Original Assignee
Neotract Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Neotract Inc filed Critical Neotract Inc
Publication of EP2658477A2 publication Critical patent/EP2658477A2/fr
Publication of EP2658477A4 publication Critical patent/EP2658477A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A—HUMAN NECESSITIES
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    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
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    • A61B17/3468—Trocars; Puncturing needles for implanting or removing devices, e.g. prostheses, implants, seeds, wires
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    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
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    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
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    • A61B2017/0479—Packages or dispensers for MIS suturing instruments
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    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A61B2017/0488—Instruments for applying suture clamps, clips or locks
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    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06052—Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
    • A—HUMAN NECESSITIES
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    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A61B2017/06095—Needles, e.g. needle tip configurations pliable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
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    • A61B17/2909—Handles
    • A61B2017/2925—Pistol grips
    • A—HUMAN NECESSITIES
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    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00547—Prostate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2002/047—Urethrae
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0008—Fixation appliances for connecting prostheses to the body
    • A61F2220/0016—Fixation appliances for connecting prostheses to the body with sharp anchoring protrusions, e.g. barbs, pins, spikes

Definitions

  • the present invention relates generally to medical devices and methods, and more particularly to systems and associated methods for manipulating or retracting tissues and anatomical or other structures within the body of human or animal subjects for the purpose of treating diseases or disorders.
  • BPH Benign Prostatic Hyperplasia
  • the prostate gland enlarges throughout a man's life.
  • the prostatic capsule around the prostate gland may prevent the prostate gland from enlarging further. This causes the inner region of the prostate gland to squeeze the urethra. This pressure on the urethra increases resistance to urine flow through the region of the urethra enclosed by the prostate.
  • the urinary bladder has to exert more pressure to force urine through the increased resistance of the urethra.
  • Chronic over-exertion causes the muscular walls of the urinary bladder to remodel and become stiffer.
  • This combination of increased urethral resistance to urine flow and stiffness and hypertrophy of urinary bladder walls leads to a variety of lower urinary tract symptoms (LUTS) that may severely reduce the patient's quality of life.
  • LUTS lower urinary tract symptoms
  • LUTS may also be present in patients with prostate cancer, prostate infections, and chronic use of certain medications (e.g. ephedrine, pseudoephedrine, phenylpropanolamine, antihistamines such as diphenhydramine, chlorpheniramine etc.) that cause urinary retention especially in men with prostate enlargement.
  • certain medications e.g. ephedrine, pseudoephedrine, phenylpropanolamine, antihistamines such as diphenhydramine, chlorpheniramine etc.
  • BPH is rarely life threatening, it can lead to numerous clinical conditions including urinary retention, renal insufficiency, recurrent urinary tract infection, incontinence, hematuria, and bladder stones.
  • Surgical procedures for treating BPH symptoms include Transurethal Resection of Prostate (TURP), Transurethral Electrovaporization of Prostate (TVP), Transurethral Incision of the Prostate (TUIP), Laser Prostatectomy and Open Prostatectomy.
  • Minimally invasive procedures for treating BPH symptoms include Transurethral Microwave Thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Interstitial Laser Coagulation (ILC), and Prostatic Stents.
  • TUMT Transurethral Microwave Thermotherapy
  • TUNA Transurethral Needle Ablation
  • ILC Interstitial Laser Coagulation
  • Prostatic Stents include Transurethral Microwave Thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Interstitial Laser Coagulation (ILC), and Prostatic Stents.
  • catheterization is indicated because the therapy actually causes obstruction during a period of time post operatively, and in other cases it is indicated because of post-operative bleeding and potentially occlusive clot formation.
  • drug therapies are easy to administer, the results are suboptimal, take significant time to take effect, and often entail undesired side effects.
  • the present invention is directed towards an apparatus and method for deploying an anchor assembly within a patient's body to accomplish the creation of a continuous defect or indentation of a lobe of a prostate to lesson obstruction or constriction of the urethra.
  • a delivery device is provided to access the anatomy targeted for the interventional procedure. The delivery device facilitates the implantation of the anchor assembly in a manner accomplishing the creation of the continuous defect or indentation. This treatment can be performed along with drug elution techniques for shrinking the prostate.
  • the delivery apparatus of the present disclosure includes various subassemblies which are mobilized via an actuator or other manually accessible structure.
  • the operation of the subassemblies is coordinated and synchronized to ensure accurate and precise implantation of an anchor assembly.
  • the delivery device is embodied in a tissue approximation assembly.
  • the present disclosure is directed towards a delivery device including a pair of extendable needles which accomplishes the delivery of a pair of distal anchor assembly components at a first location within a patient's body and the delivery of a pair of proximal anchor assembly components at a second location within the patient.
  • the device also accomplishes imparting tension during delivery to a connector to hold it while implanting the proximal anchor in situ.
  • the procedure can be viewed employing a scope inserted in the device.
  • the delivery device can be sized and shaped to be compatible with and placed inside a sheath up to 24F, preferably a 19F sheath or smaller.
  • the sheath can further include a distal end portion including an overmolding providing an atraumatic surface. Further, it is contemplated that an over jacket can be attached or form part of the sheath, where the over jacket joins a drainage lumen to the sheath.
  • the anchor assembly can be configured to accomplish approximating, retracting, lifting, compressing, supporting or repositioning tissue within the body of a human or animal subject. Moreover, the apparatus configured to deploy the anchor assembly as well as the anchor assembly itself are configured to complement and cooperate with body anatomy.
  • the anchor assembly can be coated or imbedded with therapeutic or diagnostic substances, in particular Botulinum toxin, or a silver ion coating or such substances can be introduced into or near an interventional site by the anchor deployment device or other structure.
  • therapeutic or diagnostic substances in particular Botulinum toxin, or a silver ion coating or such substances can be introduced into or near an interventional site by the anchor deployment device or other structure.
  • the anchor can include one or more distal anchors connected to one or more proximal anchors by a connector.
  • the distal anchors have a body with a tail and the proximal anchors can include a pair of spaced members which are configured to capture and deform the connector there between and prevent the connector from disengaging from the anchor device once engaged.
  • the mechanism of connector attachment and strength of the assembly is a combination of compression of the connector between deformable structure of the anchor as well as disruption of the connector surface by the anchor.
  • the deformable structure provides surface contact and focuses the compressive forces that cause the connector to conform about the anchor.
  • the anchor can include a single circular loop made from flexible material or can define a coil which can be extended and flattened for delivery. Further, the anchor can define an umbrella structure which is held closed during delivery and permitted to expand after placement at an implant site or a structure which expands in width as it contracts in length. Moreover, the anchors can embody dual struts or corkscrew structure and include a body for providing longer tissue compression lengths or can additionally include a main body with a plurality of shape set wings along its length.
  • the anchor includes a proximal portion which is sized and shaped to create a continuous defect or indentation on the lobe of the prostate.
  • the anchor can be equipped with a repeating component that can assume a folded structure at a proximal end portion.
  • the anchors can additionally or alternatively include clips intended to retain a bar that creates the continuing indentation or the anchor can be embodied in an elongate needle or trocar having a preset curved configuration.
  • the disclosed apparatus can be used to improve flow of a body fluid through a body lumen, modify the size or shape of a body lumen or cavity, treat prostate enlargement, treat urinary incontinence, support or maintain positioning of a tissue, close a tissue wound, organ or graft, perform a cosmetic lifting or repositioning procedure, form anastomotic connections, and/or treat various other disorders where a natural or pathologic tissue or organ is pressing on or interfering with an adjacent anatomical structure.
  • the present approach has a myriad of other potential surgical, therapeutic, cosmetic or reconstructive applications, such as where a tissue, organ, graft or other material requires approximately, retracting, lifting, repositioning, compression or support.
  • the disclosed apparatus are contemplated to be employed to create a continuous defect or indentation in a lobe of a prostate.
  • an anchoring device housed within a delivery device is inserted into a prosthetic urethra transurethrally and the delivery device is employed to compress or displace the prostatic lobe.
  • the anchor is then used to create the defect/indentation and to maintain the lobe in the compressed or displaced configuration.
  • FIG. 1 is a cross-sectional view, depicting anatomy surrounding a prostate in a human subject
  • FIG. 2 is an enlarged cross-sectional view, depicting anatomy surrounding a prostate
  • FIG. 3 is a schematic view, depicting prostatic anatomy zones
  • FIG. 4 is a schematic cross-sectional view, depicting further details of the anatomy zones shown in FIG. 3;
  • FIG. 5 is a cross-sectional view, depicting a normal prostate
  • FIG. 6 is a cross-sectional view, depicting a prostate with enlarged lateral lobes
  • FIG. 7 is a cross-sectional view, depicting a prostate with enlarged lateral lobes and an enlarged median lobe;
  • FIGS. 8A-D are side and perspective views, depicting one embodiment of a delivery device and various features thereof;
  • FIGS. 9A-C are perspective and side views, depicting an introducer sheath assembly and its interaction with a delivery device
  • FIGS. 10A-B are perspective views, depicting various approaches to needle deployment
  • FIGS. 11A-E are cross-sectional views, depicting sub-assemblies of the delivery device;
  • FIGS. 12A-C are partial cross-sectional views, depicting one implant delivery approach;
  • FIGS. 13A-B are partial cross-sectional views, depicting another approach to prostate treatment
  • FIGS. 14A-B are partial cross-sectional views, depicting yet another prostate treatment approach
  • FIGS. 15A-B are partial cross-sectional views, depicting a still further prostate treatment approach
  • FIGS. 16A-B are perspective views, depicting alternative approaches to an anchor assembly
  • FIGS. 17A-C are perspective and partial cross-sectional views, depicting another approach to an anchor assembly
  • FIGS. 18A-B are perspective and partial cross-sectional views, depicting a further approach to an anchor assembly
  • FIGS. 19A-B are partial cross-sectional views, depicting a yet further approach to an anchor assembly
  • FIGS. 20A-C are partial cross-sectional views, depicting an alternative distal anchor component
  • FIGS. 21A-D are side views, depicting various other alternative approaches to anchor end components;
  • FIGS. 22A-B are partial cross-sectional views, depicting further alternative approaches to distal anchor components;
  • FIGS. 23A-B are perspective views, depicting an umbrella anchor component
  • FIGS. 24A-C are perspective views, depicting alternative umbrella anchor components
  • FIGS. 25A-D are side and perspective views, depicting further alternative approaches to anchor components
  • FIGS. 26A-D are side and perspective views, depicting yet further anchor components.
  • FIGS. 27A-C are perspective and side views, depicting other anchor components.
  • the present disclosure is directed to a device configured to deliver an anchor assembly within a patient's body for treatment purposes.
  • the disclosed apparatus can be employed for various medical purposes including but not limited to retracting, lifting, compressing, approximating, supporting or repositioning tissues, organs, anatomical structures, grafts or other material found within a patient's body.
  • tissue manipulation is intended to facilitate the treatment of diseases or disorders such as the formation of a continuous defect or indentation in a lobe of a prostate.
  • the continuous defect or indentation can be an increase of a luminal opening of the urethra extending an entire length of the prostatic urethra.
  • the continuous defect or indentation can extend from the verumontanum to the bladder neck or simply be greater than a length of a structure or anchor placed to create this effect in the urethra (such as thirty percent longer in one or more directions parallel to the implanted structure).
  • one portion of an anchor assembly or implant is positioned and implanted against a first section of anatomy.
  • a second portion of the anchor assembly or implant is then positioned and implanted adjacent a second section of anatomy for the purpose of creating a continuous defect or indentation in anatomy as well as for the purpose of retracting, lifting, compressing, approximating, supporting or repositioning the first section of anatomy with respect to the second section of anatomy.
  • both a first and second portion of the anchor assembly can be configured to accomplish the desired retracting, lifting, compressing, approximating, supporting or repositioning of anatomy due to tension supplied during delivery via a connector assembly affixed to the first and second portions of the anchor assembly or implant.
  • the prostate gland PG is a walnut-sized muscular gland located adjacent the urinary bladder UB.
  • the urethra UT runs through the prostate gland PG.
  • the prostate gland PG secretes fluid that protects and nourishes sperm.
  • the prostate also contracts during ejaculation of sperm to expel semen and to provide a valve to keep urine out of the semen.
  • a capsule C surrounds the prostate gland PG.
  • the urinary bladder UB holds urine.
  • the vas deferentia VD define ducts through which semen is carried and the seminal vesicles SV secrete seminal fluid.
  • the rectum R is the end segment of the large intestine and through which waste is dispelled.
  • the urethra UT carries both urine and semen out of the body.
  • the urethra is connected to the urinary bladder UB and provides a passageway to the vas deferentia VD and seminal vesicles SV.
  • the trigone T (See FIG. 3) is a smooth triangular region of the bladder. It is sensitive to expansion and signals the brain when the urinary bladder UB is full.
  • the verumontanum VM is a crest in the wall of the urethra UT where the seminal ducts enter.
  • the prostatic urethra is the section of the urethra UT which extends through the prostate.
  • the prostate gland can be classified by zones or described by referring to its lobes (see FIG. 4). Whereas the zone classification is typically used in pathology, the lobe classification is more often used in anatomy.
  • the central zone (a) of a prostate gland PG is about 25% of a normal prostate and this zone surrounds the ejaculating ducts. There is some prevalence of benign prostate hyperplasia in the transition zone.
  • the fibromuscular zone (b) is usually devoid of glandular components and as its name suggests, is composed of only muscle and fibrous tissue.
  • the transitional zone (c) generally overlays the proximal urethra and is the region of the gland that grows throughout life. Also, this lobe is often associated with the condition of benign prostatic enlargement.
  • the peripheral zone (d) is the sub-capsular portion of the posterior aspect of the prostate gland that surrounds the distal urethra.
  • the lobe characterization is different from the zone characterization, but there is some overlap.
  • the anterior lobe is devoid of glandular tissue and is completely formed of fibromuscular tissue. This lobe thus roughly corresponds to the anterior portion of the transitional zone (c).
  • the posterior lobe roughly corresponds to the peripheral zone (d) and can be palpated through the rectum during a digital rectal exam.
  • the posterior lobe is the site of 70-80% of prostatic cancers.
  • the lateral lobe is the main mass of the prostate and is separated by the urethra. It has been described as spanning all zones.
  • the median lobe roughly corresponds to part of the central zone. It varies greatly in size and in some cases is devoid of glandular tissue.
  • a large or enlarged median lobe can act as a ball valve, blocking the bladder neck.
  • Various approaches are contemplated to address such a condition.
  • the median lobe can be compressed, displaced and/or retracted to eliminate or decrease the blocking of the bladder neck.
  • FIGS. 5-7 there are shown various prostate glands in cross-section.
  • FIG. 5 depicts the urinary bladder UB and prostate gland PG of a healthy subject.
  • FIG. 6 illustrates an individual with a prostate having enlarged lateral lobes LL and
  • FIG. 7 depicts a subject suffering from both enlarged lateral lobes LL and an enlarged median lobe ML.
  • enlarged anatomy impinges on the urethra UT and affects normal functioning.
  • the following devices and approaches are intended to be employed to free up a path through the prostatic urethra. It is contemplated that such a path can be provided by forming one or more permanent valleys along the prostatic urethra and/or creating a continuous indentation in the prostatic urethra.
  • the tissue approximation anchor is designed to be useable in an office environment (in contrast to requiring a hospital environment) with a delivery tool.
  • the delivery tool is used through a 19 Fr sheath in one preferred embodiment, while in another embodiment a sheath size of 2 IF is employed. Additionally, the material selection and construction of the tissue approximation anchor still allows for a subsequent TURP procedure to be performed, if necessary, on the prostate.
  • a needle delivery mechanism is used to implant a distal component of an anchor and attached suture or connector. Once the distal anchor component has been deployed, the needle or needles are retracted and the connector tensioned, the proximal anchor is then deployed.
  • FIGS. 8A-D there is shown one embodiment of a delivery device 100.
  • This device is configured to include structure that is capable of both gaining access to an interventional site as well as implanting and/or assembling one or more anchor assemblies or implants within a patient's body.
  • the device is further contemplated to be compatible for use with a 19F sheath.
  • the device additionally includes structure configured to receive a remote viewing device (e.g., an endoscope) so that the steps being performed at the interventional site can be observed.
  • a remote viewing device e.g., an endoscope
  • the anchor delivery device 100 includes a handle assembly 102 connected to an elongate tissue access assembly 104.
  • the elongate tissue access assembly 104 houses components employed to form an anchor assembly and is sized to fit into a 19F cystosopic sheath for patient tolerance during a procedure in which the patient is awake rather than under general anesthesia.
  • the tissue access assembly is stiff to allow manual compression of tissue at an interventional site by leveraging or pushing the handle assembly 102.
  • the anchor delivery device 100 further includes a number of subassemblies.
  • a handle case assembly 106 including mating handle parts which form part of the handle assembly 102.
  • the handle assembly 102 is sized and shaped to fit comfortably within an operator's hand and can be formed from conventional materials. Windows can be formed in the handle case assembly 106 to provide access to internal mechanisms of the device so that a manual override is available to the operator in the event the interventional procedure needs to be abandoned.
  • the delivery device 100 is equipped with various activatable members which facilitate assembly and delivery of an anchor assembly at an interventional site.
  • a needle actuator 108 is provided and as described in detail below, effectuates the advancement of one or more needle assemblies to an interventional site.
  • the needle assembly has a needle that moves through a curved trajectory and exits the needle housing in alignment with a handle element, and in particular embodiments, in alignment with the grip.
  • the needle housing is oriented such that the needles exit the housing at either the two o'clock or ten o'clock positions relative to a handle grip that is vertical.
  • a needle retraction lever assembly 110 is also provided and when actuated causes the needle assembly to be withdrawn and expose the first anchor component. This action and the structure involved is also described in detail below.
  • the delivery device 100 is equipped with a rear or proximal anchor actuator assembly 112.
  • the elongate tissue access portion 104 of a delivery device is placed within a urethra (UT) leading to a urinary bladder (UB) of a patient.
  • the delivery device can be placed within an introducer sheath (not shown) previously positioned in the urethra or alternatively, the delivery device can be inserted directly within the urethra.
  • the sheath can be attached to a sheath mount assembly (described below).
  • the patient is positioned in lithotomy.
  • the elongate portion 104 is advanced within the patient until a leading end thereof reaches the prostate gland (PG).
  • the side(s) (i.e., lobe(s)) of the prostate to be treated is chosen while the device extends through the bladder and the device is turned accordingly.
  • the distal end of the elongate portion can be used to depress the urethra into the prostate gland by compressing the inner prostate tissue.
  • the inside of the prostate gland i.e., adenoma
  • the outer surface i.e., capsule
  • the physician rotates the tool.
  • the physician pivots the tool laterally about the pubic symphysis PB relative to the patient's midline.
  • the delivery device is at this stage configured in a ready state.
  • the needle actuator 108 and the needle retracting lever 1 10 are in an inactivated position.
  • the delivery device 100 includes two needles aligned side by side or over and under the delivery device to deliver the implant.
  • the implant can include two capsular tabs attached to either end of a controlled length of suture or other connector.
  • the connector can be woven to create a relatively larger diameter in the middle of the suture.
  • the suture could have a pledget inserted over the suture to provide a broader base for the tissue under pressure to prevent the suture from cutting into the soft tissue.
  • the suture can be a continuous length so that there is no requirement for a urethral end-piece or a cutting mechanism.
  • a distal end of the delivery device 100 can be equipped with an end piece 150.
  • the end piece 150 includes a pair of spaced channels 152, each being sized and shaped to accept a single needle assembly.
  • the needle assemblies Upon depression of the needle actuator 108, the needle assemblies are advanced from within the elongate member 104.
  • the needle assemblies can be configured so that they curve back toward the handle as they are ejected.
  • the needle assemblies In use in a prostate intervention, the needle assemblies are advanced through and beyond a prostate gland (PG).
  • PG prostate gland
  • Spring deployment helps to ensure that the needle passes swiftly through the tough outer capsule of the prostate without "tenting" the capsule or failing to pierce the capsule.
  • the needle is made from Nitinol tubing and can be coated with Parylene N. Such a coating helps compensate for frictional or environmental losses (i.e.
  • the needle retraction lever 1 10 can be actuated. Such action results in a withdrawal of the needle assemblies, leaving the connector of an anchor assembly in an extended position. In one embodiment, the needles are withdrawn further than its original position within the device pre-deployment. In a prostatic interventional procedure, this action can result in delivering first or distal anchor components attached to the connector beyond an outer surface of a prostate gland (PG) with the connector within a penetration tract in the prostate gland extending toward a terminal end of a delivery device.
  • PG prostate gland
  • the delivery device can be placed within patient anatomy using an introducer sheath.
  • irrigation that is required for good visibility of the operating field can lead to pain or short-term or long-term bladder damage.
  • a cystoscopy sheath 160 (rigid or flexible) can be provided to alleviate this potential problem.
  • the sheath 160 can be equipped with a separate lumen or drainage tube 162 that may be movable along a long axis of the sheath 160 or can otherwise be positioned with one end in the patient's bladder (UB) and one end outside the patient to allow for continuous or intermittent drainage during a procedure.
  • UB patient's bladder
  • a tip assembly 170 that can be configured to be attached to an introducer sheath 160.
  • the tip assembly 170 is embodied in an overmold with a lip that snaps onto an edge of the sheath 160 and defines an atraumatic tip.
  • the tip 170 eliminates any sharp edge which might come in contact with an implant in a prostatic urethra.
  • the tip 170 can be an integral function of a sheath or can define a disposable tip that can be placed on a conventional sheath.
  • the tip 170 can be transparent so as to avoid being a visible obstruction.
  • a dual needle deploy approach to creating a continuous channel or indentation in a prostate gland is contemplated (See FIGS. 10A-B).
  • two urethral anchors or end pieces that are connected by suture, metal wire, or some other mechanism can be delivered to create a continuous indentation in the urethra.
  • the relatively larger indentation created thus provides a greater area of deformity in the urethra, reshaping the prostate and allowing greater passage of urine through the larger continuous channel.
  • the delivery device 100 deploys two needles 175 at once.
  • the needles are able to treat the same side of the prostate with a defined spacing.
  • the needles 175 can be configured to provide a small or relatively large gap upon deployment.
  • the delivery device 100 can also be adjusted to provide various desired gaps and angles of needle deployment.
  • the needle 175 can also be extended to equal or varying lengths.
  • the delivery device 100 can be equipped with a pair of spaced needle housings 180.
  • the needle housings 180 are sized and shaped to each receive a single needle.
  • the spacing of the housings 180 about a perimeter of a delivery device shaft can define the spacing and trajectory of the needles upon deployment.
  • the housings can be arranged to project needles in parallel, divergent or crossing patterns.
  • Attached to the delivery device shaft can also be a pair of spaced anchor housings 182. Contained within each anchor housing 182 is one urethral end piece or anchor 190.
  • the two anchors or end pieces are connected by a wire, suture or elastic or inelastic connector 192.
  • the needle would share a single spool 200.
  • the two needles 175 could share the same track formed in the spool 200 or could reside in parallel tracks with a divider between the two.
  • the lengths of each needle 175 may need to be adjusted to compensate for small differences in the track length so that the deployed needle lengths are the same. Efforts can likewise be taken so that the needle lengths are variable.
  • a curved or other desirable exit route can be provided to properly guide the needles 175 into tissue.
  • needle overmolds 202 can be provided at proximal end portions of a needle 175 for attachment to the spool 200. Such overmolds 202 can be staggered and/or located on opposite sides of the needle spool 200.
  • the delivery device can include a pair of cutter block assemblies 210 and a pair of pusher assemblies 212 attached to a guide wing assembly 214.
  • the cutter blocks 210 and pushers 212 can be individually molded components which are spaced upon the guide wing 214.
  • the pusher 212 advances urethral anchor components to the proper position.
  • the cutter blocks 210 are mobilized to cut the connector on a proximal side of a urethral anchor component.
  • the needles 175 are projected from the elongate shaft 104 of the delivery device 100 at desired angles from within the urethra (UT) and across the prostate (PG). In one approach, the needles 175 are extended beyond a prostate capsule. A distal anchor component 220 is then placed on an outside surface of a prostate (PG) or within the prostate (PG) or in apposition with other tissue (FIG. 12A). Next, the needles 175 are withdrawn exposing the connector 222 between the distal anchor components 220 and the proximal or urethral anchor components (FIG. 12B).
  • the proximal components are ejected from the delivery device using the pushers and the connector 222 is cut to length by the cutter assemblies (FIG. 12C).
  • the delivery device is then removed from the interventional area.
  • the connector 192 joining the proximal anchors 190 creates a continuous indentation or channel in the prosthetic urethra (UT) between the two entry points adjacent the proximal anchor 190.
  • the formation of the continuous channel in this as well as the other disclosed approaches can be undertaken along with steps to shrink the prostate.
  • drug elution can be combined with urethral expanding.
  • a specific urethral channel can be created acutely, then further enhanced by drug delivery along the channel to thereby make the acute effect more durable.
  • a needle is inserted within the prostate and prostate shrinking drugs such as pynasteride and dutasteride, or other adoptic and toxin drugs, can be injected to pass through relatively lower resistance pathways (tissue planes, fluid pathways) in the prostate. The result is that over time, the size of the prostate remains reduced and the channel created in the prostate is more durable.
  • the delivery device is employed to deliver distal anchor components in a body location displaced from the urethra (UT), such as against an exterior of a prostate (PL) capsule.
  • UT urethra
  • an elongate proximal anchor 230 attached by connectors 222 to the distal anchor components 220 is used to create a continuous indentation in a prostatic urethra (UT).
  • a simplified mechanism can be incorporated within the delivery device to accomplish the ejection and deployment of a monolithic proximal anchor. The length of such an anchor can be selected to form the desired prostatic indentation.
  • a delivery device can alternatively be configured to embody lumens crossing in different planes.
  • various crossing patterns for the anchor connectors can be achieved.
  • a two needle delivery device including a snare wire 240 that encircles both needle exit positions is provided to connect proximal anchors in situ (See FIGS. 15A-B).
  • the snare wire 240 is retracted towards the delivery system thereby pulling both connectors 222 into a capture tube, such as the elongate member 104 of the delivery device.
  • the capture tube can then be used to permanently or adjustably fix the two connectors 222 together.
  • the fixation could be via a crimp, adhesive (e.g. cyanoacrylate or two part-epoxy), polymeric remelt, or knotting, among other methods.
  • the amount of displacement of the snare wire 240 can be force-controlled or distance-controlled by the delivery device or controlled by the user in order to set an appropriate amount of tissue compression.
  • One or both needle guides 180 could be adjustable in the axial direction or in rotation to facilitate different lengths of prostates or different final suture orientations within the urethra.
  • a reloadable device (not shown) could be made in which new suture-tab assemblies are reloaded and the snare wire is reset, thereby permitting the delivery device to be reused within one patient.
  • a reloadable device could be made in which new needles, suture-tab assemblies, and possibly snare wires are reloaded thereby permitting the delivery device to be reused within a patient or possibly between patients after steam or other means of sterilization.
  • a device with only one needle could be used instead if the needle could contain and selectively deliver one capsular tab at a time and deliver two or more capsular tabs in a sequence for subsequent joining.
  • the delivery device could also have more than two needles and deliver more than two capsular tabs for subsequent joining.
  • the snare wire is secured in a snare wire holder 242 such that the needles 175 are routed inside the snare wire loop 240.
  • the snare wire 240 is pulled proximal thereby pulling the connector 222 towards and into the snare wire capture tube 140. Tension is at this time applied to the connectors.
  • the snare wire capture tube 140 would contain adhesive or a crimp tip or ferrule (not shown) to permanently join the connectors.
  • the snare wire 204 itself could be the joining device a slip knot or snare wire could be advanced such that they are fixed relative to each other. Accordingly, the snare wire 244 or other connector attaching structure is thus positioned to form the continuous urethral indentations 250.
  • an anchor assembly 260 can include an elastic member 262 connecting first and second generally elongate, split anchor members 264. The length of such anchor members can be selected for providing a secure footing as well as to create the desired channel in body tissue.
  • the anchor 270 can be one continuous structure including a connector 272 made from metal, for example, which connects anchor members 274.
  • an anchor assembly 280 embodying a repeating geometric capsular or distal anchor component 282 with a continuously locking urethral or proximal component 284 can be employed to create a desired indentation or channel.
  • the repeating geometric structure enables a physician or other operator to use the anchor 280 in multiple applications where patient anatomy is varied.
  • the locking structure of the proximal component allows for the proximal component to define a closed structure for use in creating the channel or indentation in the urethral prostate.
  • the anchor assembly 290 can embody a distal component 292 and a proximal component formed by a polymer or metal tape or bar 294 with holes or slits (at least two) along its length.
  • a delivery instrument positions the bar/tape against the prostate lobe and delivers an anchor system 290 or equivalent through each slit or hole in the bar/tape.
  • the delivery system would contain at least one needle each housing at least one distal anchor 292 attached to a length of suture 298. It would also contain at least two proximal anchors 296 that lock the bar/tape 294 to the suture 298.
  • One variation is to add barbs or bumps (not shown) to the suture 298 that would allow for adjustment and in the bar position and anchoring of the bar without the use of a proximal anchor 296.
  • Another variation is to have a single suture connect to a long leaf spring (not shown) in the urethra which is formed by insertion of a balloon or by a mechanical feature in the delivery instrument.
  • Yet another variation would involve a single proximal anchor connected to two distal anchors.
  • FIGS. 19A-B A further approach to structure for creating a continuous channel is shown in FIGS. 19A-B.
  • the defect or channel forming structure is embodied in a stainless steel, polymer, or Nitinol needle or curved wire 300 that acts as a single-piece implanted tissue anchor.
  • the anchor is delivered first through the urethral wall (UT), then through the capsular wall of the prostate (PG).
  • the anchor 300 bends back on itself as its feeds out of distal portion of a delivery device 104, until it is released completely from the device. It may be a shape-memory material or it may be formed as it is fed out of the delivery device (e.g. SS curls onto itself as it is cold worked).
  • the implant 300 takes shape when deployed by a delivery instrument due to pre-set shape (Nitinol) or due to interaction with delivery device upon release.
  • the wire or needle 300 has multiple proximal ends for engaging a proximal side of the prostate gland.
  • an anchor assembly 310 including a single circular loop 312 made from a flexible material can define a distal component.
  • a suture 314 is attached to one end of the loop.
  • the anchor is delivered through a minimally invasive small diameter cannula or needle 175.
  • This type of anchor has the ability to fit within a small cannula or needle due to its flexible nature.
  • the loop 312 springs back to its original circular loop shape. Since the diameter of this anchor is significantly larger than the hole created by the cannula/needle, the anchor cannot slip back into the hole that it was introduced through.
  • the loop is a one piece design with no articulating joints. As tension is applied to the suture the geometric shape of the anchor is self centering and would anchor in any orientation. It is contemplated that the anchor can be made from a variety of flexible materials ranging from Nitinol, polymers, titanium or stainless steel.
  • an anchor 320 can embody other structure requiring a small delivery geometry to permit minimally invasive insertion and a large in situ geometry to help engage tissue for maximum holding force.
  • a tissue anchor defining a hoop that expands in width as it contracts in length is contemplated. The width expansion is relatively large compared to the length contraction (See FIG. 2 ID).
  • the device can be a wire form made from a shape memory or other metal or it could be a molded polymer with sufficient elasticity to survive the shape transformation. It could be encased in a membrane, a polymeric sack, or encapsulated in an elastomer to provide biocompatibility, tissue ingrowth, drug delivery, or mechanical stability features.
  • the wire form can define a continuous structure (FIG. 2 IB) or can define a loop with a pair of unconnected terminal ends 322.
  • a weld or adhesive 324 can be employed to join ends of the wire to create a closed structure.
  • the anchor assembly 330 can also include a tissue anchor 332 having a pre-set coiled shape.
  • the coiled tissue anchor 332 is attached at its proximal end to a suture or other connector structure 334.
  • the coiled portion assumes an elongated configuration.
  • the coiled anchor Upon release at the interventional site, the coiled anchor returns to its pre-set shape to provide the desired tissue engaging function.
  • the anchor assembly 340 includes an expandable frame 342 connected to a plurality of connecting members or sutures 344.
  • an anchor assembly 350 including an umbrella frame 352 can be attached to a single suture 354.
  • the tissue anchoring system 340 can consist of three or more lengths of suture 344 and a metal or plastic anchor 342 with stiff linkages connected by flexible joints which allow it to take on a folded state and an unfolded state.
  • the system may also consist of a secondary anchor or multiple secondary anchors that are attached to the opposite end(s) of the suture(s) after the primary anchor has been delivered.
  • the umbrella anchor 340 may be delivered on the outside of a trocar, which facilitates a smaller delivery system, since the trocar can be of a relatively smaller diameter.
  • Multiple sutures 344 attached to a single primary anchor provide a strong system which can withstand higher loads if the sutures are bundled together and attached to a single secondary anchor.
  • the system can treat multiple tissue areas with a single primary anchor.
  • the umbrella anchor is intended to cover a large area of tissue. This results in the creation of a larger defect on the primary tissue plane.
  • the folding anchor 350 attached to a single length 354 of suture can be delivered from within a needle, but otherwise functions the same.
  • a proximal anchor component can also define a dual strut anchor 360 including a pair of anchor prongs 362 extending from a body 364, the prongs 362 providing long-length tissue compression.
  • the body 364 can further be attached to one end of a connector 366, the opposite end of which is secured to a distal anchor component 368 could be fabricated from stainless steel or Nitinol.
  • both anchor prongs 362 are held together in the delivery device and then the prongs 362 would unfold to provide long-length tissue compression upon implantation.
  • the proximal anchor can also be defined by an anchor housing a cork-screw body 370.
  • the corkscrew anchor provides a means to screw the anchor onto a connector 372. This concept could be used to deploy the anchor straight out from the distal end of a delivery device.
  • anchor structure 380 can be formed or drawn tubing that is cut for suture or connector capture features.
  • Numerous alternative geometries for the anchor exist, where the anchor 380 was a solid sheet that was laser cut.
  • the anchor could be multiple parts that are assembled and puzzle pieced together after suture capture to form a larger area for tissue approximation.
  • the disclosed anchor assemblies are configured across anatomy within the interventional site.
  • a continuous channel or indentation is formed in the prostate or prostatic urethra due to the anchor assembly compressing the surrounding enlarged prostate tissue due to the fact that the outer capsular tissue is rather strong, substantially non- compressible and non-displaceable while the adenoma of the prostate gland is compressible and the urethral wall displaceable.
  • a second catheter (not shown) with a vision system may be advanced into the urinary bladder UB to allow verification of anchor placement and tensioning from within the urinary bladder UB.
  • the catheter or device may be flexible, rigid or semi-rigid.
  • the needle may exit at the tip of the device, or may exit at the side of the device. Some portion or the entire catheter or device may have articulation control to allow for navigating and positioning.
  • the present invention contemplates both pushing directly on anchor portions of an anchor assembly as well as pushing directly upon the connector of the anchor assembly.
  • the distal or first anchor component is advanced and deployed through one or more needle assemblies and at least one component of the proximal or second anchor component is advanced and deployed from a housing portion of the anchor deployment device.
  • either a single anchor assembly or multiple anchor assemblies can be delivered and deployed at an intervention site by the deployment device.
  • a single anchor assembly component can for example, be placed on one side of a prostate or urethra while multiple anchor assembly components can be positioned along an opposite or displaced position of such anatomy.
  • the number and locations of the anchor assemblies can thus be equal and/or symmetrical, different in number and asymmetrical, or simply
  • the present invention is used for the compression of the prostate gland and the opening of the prostatic urethra, the delivering of an implant at the interventional site, and applying tension between ends of the implant.
  • drug delivery is both contemplated and described as a further remedy in BPH and over active bladder treatment as well as treating prostate cancer and prostatitis.
  • the anchor assembly of the present invention accomplishes desired defect formation, tissue manipulation, approximation, compression or retraction as well as cooperates with the target anatomy to provide an atraumatic support structure.
  • the shape and contour of the anchor assembly is configured so that the assembly invaginates within target tissue, such as within natural folds formed in the urethra by the opening of the urethra lumen by the anchor assembly.
  • target tissue such as within natural folds formed in the urethra by the opening of the urethra lumen by the anchor assembly.
  • wispy or pillowy tissue in the area collapses around the anchor structure.
  • the natural tissue can grow over the anchor assembly and new cell growth occurs over time.
  • Such cooperation with target tissue facilitates healing and avoids unwanted side effects such as calcification or infection at the interventional site.
  • the patient can be directed to take alpha blockers for 2-4 weeks.
  • Anti-inflammatory medicine can also be taken.
  • the present invention also contemplates approaches to accelerate healing or induce scarring.
  • Manners in which healing can be promoted can include employing abrasive materials, textured connectors, biologies and drugs.
  • the components of the anchor assembly or selected portions thereof can be coated or embedded with therapeutic or diagnostic substances (e.g. drugs or therapeutic agents).
  • therapeutic or diagnostic substances e.g. drugs or therapeutic agents.
  • the anchor assembly can be coated or imbedded with substances such as 5-alpha-reductase which cause the prostate to decrease in size.
  • substances contemplated include but are not limited to phytochemicals generally, alpha- 1 a-adrenergic receptor blocking agents, smooth muscle relaxants, and agents that inhibit the conversion of testosterone to dihydrotestosterone.
  • the connector can for example, be coated with a polymer matrix or gel coating which retains the therapeutic or diagnostic substance and facilitates accomplishing the timed release thereof.
  • bacteriostatic coatings as well as analgesics and antibiotics for prostatitis and other chemical coatings for cancer treatment, can be applied to various portions of the anchor assemblies described herein.
  • Such coatings can have various thicknesses or a specific thickness such that it along with the connector itself matches the profile of a cylindrical portion of an anchor member affixed to the connector.
  • the co-delivery of a therapeutic or diagnostic gel or other substances through the implant deployment device or another medical device i.e.
  • the deployment device includes a reservoir holding the gel substance and through which an anchor device can be advance to pick up a desired quantity of therapeutic or diagnostic gel substance.
  • the anchor delivery device can include the ability to detect forces being applied thereby or other environmental conditions.
  • Various sections of the device can include such devices and in one contemplated approach sensors can be placed along the needle assembly. In this way, an operator can detect for example, whether the needle has breached the target anatomical structure at the interventional site and the extent to which such breaching has occurred.
  • sensors which can detect particular environmental features can also be employed such as blood or other chemical or constituent sensors.
  • one or more pressure sensors or sensors providing feedback on the state of deployment of the anchor assembly during delivery or after implantation are contemplated. For example, tension or depth feedback can be monitored by these sensors. Further, such sensors can be incorporated into the anchor assembly itself, other structure of the deployment device or in the anatomy.
  • connection of an anchor assembly can be severed and a proximal (or second) anchor component removed from the patient's body.
  • the physician can cut the connector and simultaneously remove the second anchor previously implanted for example, in the patient's urethra using electrosurgical, surgical or laser surgical devices used in performing transurethral prostate resection.
  • An aspect that the various embodiments of the present invention provide is the ability to deliver an anchor assembly having a customizable length, each anchor assembly being implanted at a different location without having to remove the device from the patient.
  • Other aspects of the various embodiments of the present invention are load-based delivery, of an anchor assembly, anchor assembly delivery with a device having integrated connector, (e.g. suture), cutting, and anchor assembly delivery with an endoscope in the device.
  • the delivery device is uniquely configured to hold the suture with tension during delivery to help ensure that the first anchor component sits firmly against a tissue plane (e.g., the outer capsule of the prostate) and is held relatively firm as the second anchor component is attached to the connector and the delivery device.
  • the needle assembly acting as a penetrating member is cooperatively connected to a mechanism which pulls on the anchor while the needle assembly is retracted.
  • one or more components such as distal anchor, proximal anchor, and connector, of the one or more anchor devices disclosed herein can be completely or partially biodegradable or biofragmentable.
  • the devices and methods disclosed herein can be used to treat a variety of pathologies in a variety of lumens or organs comprising a cavity or a wall.
  • lumens or organs include, but are not limited to urethra, bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins (e.g. for treating varicose veins or valvular insufficiency), arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc.

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Abstract

L'invention concerne un système et un procédé associé de manipulation de tissus et de structures anatomiques ou autres dans des applications médicales ayant pour but de traiter des maladies ou des troubles ou d'autres objectifs. Selon un aspect, le système comprend un dispositif de libération conçu pour déployer et implanter des dispositifs pour créer des défauts continus ou renfoncements dans les lobes d'une prostate.
EP11852778.7A 2010-12-27 2011-12-16 Appareil et procédé de renfoncement continu de lobe latéral Withdrawn EP2658477A4 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12/979,089 US8834492B2 (en) 2005-05-20 2010-12-27 Continuous indentation lateral lobe apparatus and method
PCT/US2011/065386 WO2012091956A2 (fr) 2010-12-27 2011-12-16 Appareil et procédé de renfoncement continu de lobe latéral

Publications (2)

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EP2658477A2 true EP2658477A2 (fr) 2013-11-06
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US9931192B2 (en) 2018-04-03
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US8834492B2 (en) 2014-09-16
WO2012091956A3 (fr) 2012-08-23
US20110160747A1 (en) 2011-06-30

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